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1.
J Craniofac Surg ; 31(5): 1202-1207, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32282680

RESUMO

INTRODUCTION: Syrian patients injured in the war frequently undergo rudimentary primary wound closure in combat zones. These patients are later transferred to Lebanon where their wounds need to be secondarily managed. This often leads to the creation of unorthodox approaches for reconstruction of orbital injuries. CASE PRESENTATION: The authors of this manuscript demonstrate a few cases of peri-ocular trauma with a delayed presentation, in which adaptations of conventional reconstructive methods had to be implemented had to be undertaken for optimal results. CONCLUSION: Modified techniques for reconstruction of peri-ocular injuries with delayed presentation are discussed in this paper. The patients are cases of trauma secondary to war in the region of Lebanon and Syria. The unique presentations of these patients have led to the use of "opportunity flaps" surrounding highly fibrotic and scarred tissue, in an attempt to allow for delayed reconstruction.


Assuntos
Face/cirurgia , Traumatismos Faciais/cirurgia , Adulto , Conflitos Armados , Humanos , Masculino , Procedimentos de Cirurgia Plástica , Retalhos Cirúrgicos , Síria , Adulto Jovem
2.
Pediatr Blood Cancer ; 66(11): e27959, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31423715

RESUMO

Retinoblastoma is an ocular tumor that occurs in young children, in either heritable or sporadic manner. The relative rarity of retinoblastoma, and the need for expensive equipment, anesthesia, and pediatric ophthalmologic expertise, are barriers for effective treatment in developing countries. Also, with an average age-adjusted incidence of two to five cases per million children, patient number limits development of local expertise in countries with small populations. Lebanon is a small country with a population of approximately 4.5 million. In 2012, a comprehensive retinoblastoma program was formalized at the Children's Cancer Institute (CCI) at the American University of Beirut Medical Center, and resources were allocated for efficient interdisciplinary coordination to attract patients from neighboring countries such as Syria and Iraq, where such specialized therapy is also lacking. Through this program, care was coordinated across hospitals and borders such that patients would receive scheduled chemotherapy at their institution, and monthly retinal examinations and focal laser therapy at the CCI in Lebanon. Our results show the feasibility of successful collaboration across borders, with excellent patient and physician adherence to treatment plans. This was accompanied by an increase in patient referrals, which enables continued expertise development. However, the majority of patients presented with advanced intraocular disease, necessitating enucleation in 90% of eyes in unilateral cases, and more than 50% of eyes in bilateral cases. Future efforts need to focus on expanding the program that reaches to additional hospitals in both countries, and promoting early diagnosis, for further improvement of globe salvage rates.


Assuntos
Institutos de Câncer/organização & administração , Países em Desenvolvimento , Hospitais Universitários/organização & administração , Internacionalidade , Colaboração Intersetorial , Neoplasias da Retina/terapia , Retinoblastoma/terapia , Institutos de Câncer/economia , Terapia Combinada/economia , Terapia Combinada/métodos , Diagnóstico Tardio , Gerenciamento Clínico , Estudos de Viabilidade , Feminino , Aconselhamento Genético , Hospitais Universitários/economia , Humanos , Incidência , Lactente , Recém-Nascido , Estimativa de Kaplan-Meier , Líbano/epidemiologia , Masculino , Oriente Médio/epidemiologia , Equipe de Assistência ao Paciente , Encaminhamento e Consulta , Neoplasias da Retina/diagnóstico , Neoplasias da Retina/epidemiologia , Retinoblastoma/diagnóstico , Retinoblastoma/economia , Retinoblastoma/epidemiologia , Resultado do Tratamento , Estados Unidos
3.
Case Rep Ophthalmol ; 10(3): 403-407, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31911782

RESUMO

A child was referred for removal of an eyelid mass. She had preseptal cellulitis and a large tick deeply embedded in the tarsus of the upper eyelid necessitating antibiotic therapy and en-bloc excision of the tick with the attached eyelid portion. Large ticks that are embedded in the eyelid are best treated surgically with en-bloc excision of the tick and its attached lid. On the contrary, for small ticks involving the very superficial skin, fine-tipped tweezers can be used to grasp the insect. Ticks are vectors of several diseases like Lyme borreliosis, hence prophylactic antibiotic treatment and close observation are recommended.

4.
Orbit ; 29(6): 343-5, 2010 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-21158575

RESUMO

A 28-year-old female presented with hyperglobus and inferior scleral show after the repair of an orbital floor fracture using a porous polyethylene (Medpor) implant. CT revealed a large inferior orbital cystic mass displacing the globe. The cyst was explored and excised and the implant was found to be free from any attachment to surrounding tissues and hence, removed without difficulty. The reason for the cyst development was most likely inadvertent epithelial inclusion at the time of surgery-a recognized risk with insertion of any foreign body via transconjunctival approach. Porous implants when placed in the subperiosteal space might not get incorporated with surrounding tissues and therefore behave like any traditional nonporous alloplastic material.


Assuntos
Cistos/etiologia , Doenças Orbitárias/etiologia , Fraturas Orbitárias/cirurgia , Implantes Orbitários/efeitos adversos , Polietilenos/efeitos adversos , Adulto , Materiais Biocompatíveis/efeitos adversos , Cistos/diagnóstico por imagem , Cistos/cirurgia , Remoção de Dispositivo , Feminino , Seguimentos , Humanos , Doenças Orbitárias/diagnóstico por imagem , Doenças Orbitárias/cirurgia , Fraturas Orbitárias/diagnóstico por imagem , Falha de Prótese , Reoperação , Tomografia Computadorizada por Raios X/métodos
5.
Ophthalmic Plast Reconstr Surg ; 26(3): 214-5, 2010.
Artigo em Inglês | MEDLINE | ID: mdl-20489552

RESUMO

A 62-year-old male presented with multiple bilateral eyelid margin verruca vulgaris. Treatment with surgical excision and cauterization of the bases was done twice, but the lesions recurred rapidly with more extensive involvement of the eyelid margins. Excision and intraoperative application of mitomycin C (0.2 mg/ml) for 3 minutes using Weck-Cel sponges resulted in no recurrence seen at the 8-month follow-up.


Assuntos
Antibióticos Antineoplásicos/uso terapêutico , Doenças Palpebrais/tratamento farmacológico , Doenças Palpebrais/cirurgia , Mitomicina/uso terapêutico , Verrugas/tratamento farmacológico , Verrugas/cirurgia , Terapia Combinada , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Oftalmológicos , Recidiva
7.
Ophthalmic Plast Reconstr Surg ; 22(4): 310-1, 2006.
Artigo em Inglês | MEDLINE | ID: mdl-16855512

RESUMO

A 32-year-old woman presented with bilateral lower eyelid margin erosion and erythema of several years' duration. She reported no improvement with the use of topical corticosteroid therapy. A full-thickness excisional biopsy was performed, and the histopathology of the specimens was consistent with lichen planus.


Assuntos
Doenças Palpebrais/patologia , Líquen Plano/patologia , Adulto , Biópsia , Doenças Palpebrais/cirurgia , Feminino , Humanos , Líquen Plano/cirurgia
9.
Ophthalmic Plast Reconstr Surg ; 21(5): 356-8, 2005 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-16234698

RESUMO

PURPOSE: To assess the efficacy of full-thickness mucous membrane grafts in forming a total and permanent corneal cover. METHODS: The records of all patients with a phthisical globe or microphthalmos who underwent a corneal covering procedure to allow comfortable wearing of a cosmetic scleral shell between March 1999 and July 2004 were reviewed. RESULTS: Ten eyes underwent a Gunderson conjunctival flap (group A), and 9 eyes underwent a full-thickness mucous membrane graft (group B). In group A, 3 eyes had total flap retraction and one eye had partial flap retraction. In group B, only one eye had partial graft retraction. The flap retraction in group A occurred in those eyes with a corneal diameter of 9 mm or more. CONCLUSIONS: The results from this small series of patients indicate that a full-thickness mucous membrane graft might be a better alternative for corneal coverage than a Gunderson conjunctival flap, especially in eyes with conjunctival scarring or relatively large corneal diameter.


Assuntos
Túnica Conjuntiva/cirurgia , Córnea/cirurgia , Mucosa Bucal/transplante , Ajuste de Prótese , Esclera , Retalhos Cirúrgicos , Adulto , Idoso , Criança , Pré-Escolar , Olho Artificial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
10.
Arch Ophthalmol ; 122(8): 1137-40, 2004 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-15302653

RESUMO

OBJECTIVE: To evaluate the efficacy of intravitreal triamcinolone acetonide in the management of persistent macular edema secondary to nonischemic central retinal vein occlusion (CRVO). METHODS: Twenty consecutive patients were selected with a 3- to 4-month history of nonischemic CRVO and persistent macular edema. These patients received a single intravitreal injection of 4 mg of triamcinolone acetonide (40 mg/mL). The follow-up period ranged from 10 to 12 months. The amount of macular edema was assessed by the amount of retinal thickening on clinical examination using the Goldmann contact lens and by the area and intensity of staining on fluorescein angiography. Treated patients were compared with a retrospectively matched group of patients who were managed with observation only. MAIN OUTCOME MEASURES: Changes in visual acuity and amount of macular edema were assessed in the treated patients and compared with the observation group. RESULTS: The mean baseline visual acuity in the treatment group was 20/132 vs 20/123 for the observation group (P =.57). After 1 week, the treated group had a mean visual acuity of 20/51. At final follow-up, the treated group had a mean visual acuity of 20/37 while the observation group had a mean visual acuity of 20/110 (P =.001). Sixty percent of treated patients had a final visual acuity of 20/40 or better vs only 20% in the observation group (P =.01). Forty percent of the untreated patients had a final visual acuity worse than 20/200 while none of the treated patients did (P<.001). At final follow-up, 75% of treated patients had complete resolution of macular edema on clinical examination vs only 20% of the untreated patients (P<.001). Two of the treated patients had recurrence of macular edema at 6 months, and 3 had elevated intraocular pressure. CONCLUSION: This study shows a treatment benefit from intravitreal triamcinolone in terms of visual acuity and macular edema for nonischemic CRVO.


Assuntos
Glucocorticoides/uso terapêutico , Edema Macular/tratamento farmacológico , Oclusão da Veia Retiniana/tratamento farmacológico , Triancinolona Acetonida/uso terapêutico , Idoso , Feminino , Angiofluoresceinografia , Humanos , Injeções , Pressão Intraocular , Edema Macular/etiologia , Masculino , Pessoa de Meia-Idade , Oclusão da Veia Retiniana/complicações , Acuidade Visual , Corpo Vítreo/efeitos dos fármacos
11.
Ophthalmic Plast Reconstr Surg ; 20(3): 240-1, 2004 May.
Artigo em Inglês | MEDLINE | ID: mdl-15167735

RESUMO

The standard glass tube used with a conjunctivodacryocystorhinostomy is subject to spontaneous displacement or extrusion, especially in the early postoperative period. To anchor the tube in the surrounding tissues, a suture is commonly tied around the collar of the Pyrex tube and externalized to the skin of the medial canthal area where it is fixed. The loop can become loose around the tube, and displacement or extrusion can occur. We describe an alternative method to better secure the tube in place during the early postoperative period and until the time when the tissues around the tube contract.


Assuntos
Túnica Conjuntiva/cirurgia , Dacriocistorinostomia/métodos , Próteses e Implantes , Migração de Corpo Estranho/prevenção & controle , Humanos , Técnicas de Sutura
12.
Ophthalmic Plast Reconstr Surg ; 20(2): 144-9, 2004 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-15083084

RESUMO

PURPOSE: To describe 3 cases of upper eyelid retraction after glaucoma filtering surgery and topical application of mitomycin C and to highlight possible causes. METHODS: A report of 3 patients, identified over an 8-year interval period, who had development of upper eyelid retraction a few months after undergoing trabeculectomy with mitomycin C in the ipsilateral eye. RESULTS: Testing for Graves disease, including second-generation thyrotropin receptor antibodies (TRAb), was negative in all cases. A complete physical examination was performed by an internist: Orbital and intracranial neuroimaging studies were ordered when necessary, and all were negative. One patient underwent surgical repair of the eyelid retraction and had a satisfactory result. CONCLUSIONS: Upper eyelid retraction after filtering surgery is a rarely reported entity. Müller muscle overaction, independent of Graves disease, is a likely cause and has been pointed out as a possible factor in one previous report. Müller muscle fibrosis, euthyroid Graves disease, and mechanical hindrance to an elevated bleb are other possible factors.


Assuntos
Antibióticos Antineoplásicos/administração & dosagem , Doenças Palpebrais/etiologia , Glaucoma de Ângulo Aberto/cirurgia , Mitomicina/administração & dosagem , Trabeculectomia/efeitos adversos , Administração Tópica , Adolescente , Adulto , Túnica Conjuntiva/efeitos dos fármacos , Doenças Palpebrais/cirurgia , Feminino , Glaucoma de Ângulo Aberto/tratamento farmacológico , Humanos , Pressão Intraocular , Masculino
13.
Ophthalmic Plast Reconstr Surg ; 19(6): 446-8, 2003 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-14625490

RESUMO

PURPOSE: To investigate the effectiveness of anterior canthal tendon release in the management of centurion syndrome. METHODS: Four patients diagnosed as having the centurion syndrome were treated over a period of 3 years. They all underwent bilateral anterior canthal tendon release under local anesthesia. RESULTS: None of these patients had adequate apposition of the lower puncta after surgery. One patient had partial relief of epiphora on one side. CONCLUSIONS: Our results indicate that anterior canthal tendon release is insufficient as a sole treatment for patients with centurion syndrome.


Assuntos
Anormalidades do Olho/cirurgia , Pálpebras/anormalidades , Pálpebras/cirurgia , Doenças do Aparelho Lacrimal/cirurgia , Tendões/cirurgia , Adulto , Anormalidades do Olho/patologia , Pálpebras/patologia , Humanos , Doenças do Aparelho Lacrimal/patologia , Masculino , Síndrome
14.
Ophthalmic Surg Lasers Imaging ; 34(5): 413-6, 2003.
Artigo em Inglês | MEDLINE | ID: mdl-14509470

RESUMO

Pars plana vitrectomy in eyes with an anterior chamber intraocular lens poses several challenges. This becomes more obvious during fluid-air exchange. The use of viscoelastics during the surgery to overcome these problems is described. This technique allows better visibility intraoperatively, provides a stable anterior chamber, and maintains corneal clarity.


Assuntos
Câmara Anterior/efeitos dos fármacos , Ácido Hialurônico/uso terapêutico , Lentes Intraoculares , Descolamento Retiniano/cirurgia , Perfurações Retinianas/cirurgia , Vitrectomia/métodos , Idoso , Criança , Feminino , Humanos , Implante de Lente Intraocular/métodos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Resultado do Tratamento , Acuidade Visual
15.
Ophthalmic Plast Reconstr Surg ; 19(4): 327-30, 2003 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-12878886

RESUMO

A 27-year-old man sustained a blast injury to the face in April 1996, with a resultant foreign body at the right medial orbital wall. He refused to undergo surgical removal of the foreign body at that time and was discharged on oral antibiotics. Five years later, he presented because of recurrent attacks of swelling, redness, and pain at the right medial canthal area. A repeat computed tomography (CT) scan revealed fragmentation of the original orbital foreign body and an adjacent radiodense lesion that appeared to blend smoothly with the orbital bone from which it arose. This lesion was not present on the initial CT scan done 5 years earlier immediately following the blast. The patient was started on oral antibiotics and surgical exploration was carried out. Three fragments of the foreign body were removed in addition to the adjacent orbital lesion, which proved to be an ivory-type osteoma on histopathology. We briefly review previously suggested factors in the pathogenesis of osteoma and present further evidence in favor of both traumatic and infectious factors.


Assuntos
Traumatismos por Explosões/patologia , Corpos Estranhos no Olho/patologia , Ferimentos Oculares Penetrantes/patologia , Órbita/lesões , Neoplasias Orbitárias/patologia , Osteoma/patologia , Adulto , Corpos Estranhos no Olho/diagnóstico por imagem , Corpos Estranhos no Olho/cirurgia , Ferimentos Oculares Penetrantes/diagnóstico por imagem , Ferimentos Oculares Penetrantes/cirurgia , Humanos , Masculino , Neoplasias Orbitárias/diagnóstico por imagem , Neoplasias Orbitárias/cirurgia , Osteoma/diagnóstico por imagem , Osteoma/cirurgia , Tomografia Computadorizada por Raios X
16.
Ophthalmic Surg Lasers ; 33(6): 445-9, 2002.
Artigo em Inglês | MEDLINE | ID: mdl-12449217

RESUMO

BACKGROUND AND OBJECTIVE: To describe the use of fascia lata to cover the polypropylene knots of scleral fixated posterior chamber intraocular lenses (PCIOL). PATIENTS AND METHODS: Fascia lata was used to cover the knots of scleral fixated PCIOL in 5 eyes with significant scleral thinning. Four of the 5 eyes had the PCIOL insertion and the fascia lata patching in the same setting. The fifth eye previously had scleral fixated PCIOL with late suture erosion through a partial thickness scleral flap. RESULTS: There was no suture exposure or graft thinning throughout a follow-up period of 8 to 16 months. The eyes tolerated the fascia lata well with no early or late postoperative complications. CONCLUSION: Fascia lata provides an effective means to cover the knots of scleral fixated PCIOL, especially in aphakic patients with significant scleral thinning.


Assuntos
Fascia Lata/transplante , Implante de Lente Intraocular/métodos , Esclera/cirurgia , Adulto , Idoso , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Técnicas de Sutura , Coleta de Tecidos e Órgãos/métodos , Resultado do Tratamento , Acuidade Visual
18.
Ophthalmic Plast Reconstr Surg ; 18(4): 285-8, 2002 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-12142762

RESUMO

PURPOSE: To assess the efficacy of intraoperative mitomycin C in improving the success rate of the posterior punctectomy procedure. METHODS: The charts of all patients who underwent posterior punctectomy between the years 1997 and 2000 were reviewed. The procedure was done without mitomycin C (n = 26 eyes, group A) until the end of 1998 and with mitomycin C (n = 25 eyes, group B) starting in 1999. The Kaplan-Meier curve was used for statistical evaluation. RESULTS: In group A, 5 of 26 (19.2%) eyes had complete anatomic obstruction and scarring of their puncta after surgery, compared with 0 of 25 (0.0%) eyes in group B. The difference was statistically significant (P<0.02). No significant complications were observed. CONCLUSIONS: Mitomycin C appears to be a safe and effective adjunct therapy in correcting punctal stenosis.


Assuntos
Antibióticos Antineoplásicos/uso terapêutico , Doenças Palpebrais/tratamento farmacológico , Obstrução dos Ductos Lacrimais/tratamento farmacológico , Mitomicina/uso terapêutico , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cicatrização
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